Injury Prevention Program
U.S. Army Public Health Command
Aberdeen Proving Ground, Maryland
In response to a recent anonymous U.S. Army Public Health Command survey about injuries, one healthcare provider noted, “We spend time and money training a Soldier to become ‘physically fit’ — but because we don’t do this right — we over-train them to the point of injury — so they are given restricted duties or medically discharged before they can ever fight our wars.” This comment represents a scientifically supported and long-documented problem. In fact, the primary health threat to troops for more than two decades has been common muscle, joint, tendon/ligament and bone injuries like knee or back pain caused by running and sports and exercise-related activities such as basketball and weightlifting. These activities are not just a primary cause of injuries stateside, but also at deployed locations.
“Non-battle injuries resulted in more medical air evacuations from Afghanistan and Iraq than battle injuries,” said Keith Hauret, an epidemiologist at the USAPHC. “The leading causes of these non-battle injuries were physical training and sports.”
In addition to reducing force readiness, these injuries cause temporary or even permanent disability and limit the physical capability of thousands of active-duty service members each year. The impacts to the Army’s bottom line include millions of clinic visits annually, millions of lost or restricted duty days and millions of dollars in medical costs.
The Army places a great deal of emphasis on training Soldiers so they are fit and capable of successfully performing their physically demanding jobs. However, physical training can stress the body and cause various muscle, skeletal, tendon or ligament injuries. Soldiers can also get caught up in the competitive nature of sports programs and overdo it, resulting in sprains, strains or more severe injuries. The benefits of exercise must be balanced with the risk of injuries.
“Fit, healthy and uninjured Soldiers are what make an exceptional Army,” said Maj. Tanja Roy, an epidemiologist at the USAPHC. “Unit leaders should follow proper physical training guidance and be careful to avoid over-training Soldiers with too much running or improperly instructed exercises.”
Many injury prevention experts believe leaders need to change their approach regarding Soldiers who struggle to pass their fitness test. To some healthcare providers it is sadly ironic that remedial PT programs often force less fit individuals to work out more, which ultimately increases risk of injury and costly chronic conditions — especially as these Soldiers age. They report that some Soldiers are forced to run every day and are plagued with lower back and knee pain.
Reconditioning PT is intended to help injured Soldiers stay fit while not aggravating their injury. Unfortunately, many units are not following well-designed reconditioning programs and are instead further injuring their Soldiers. In the USAPHC survey, one Army medical provider noted, “I am currently seeing a patient for an ankle fracture. He is in a cast and on crutches, yet was forced to walk for his PT.”
All Soldiers, and especially leaders, should be aware of behaviors or conditions that increase the risk of exercise-related injuries and the training principles that can help prevent them. Examples include:
• Excessive running is the most common cause of overuse injuries, especially in feet, ankles or lower legs. These can be avoided by using a training regimen that alternates with days of low-impact aerobic workouts (e.g., swimming, biking or rowing) and days of strength training. Running distances and durations should be slowly increased over time, and Soldiers should not be forced to run if injured. Cadence unit runs are not recommended, and group runs should be organized by pace and distance abilities.
• Balanced physical fitness programs should mix aerobic, strength and agility drills, and conditioning exercises. Scientific studies of the Army’s Physical Readiness Training Program (in Army Field Manual 7-22) showed that units following a PRT program had significantly lower injury rates than those following a run-centric PT regimen.
• Basketball injuries primarily involve the foot or ankle. Scientific studies have shown that using semi-rigid ankle braces during basketball significantly reduces the risk of a recurring ankle injury. Science has also shown that using mouth guards during basketball reduces the number of people with broken teeth and other mouth-related injuries.
• Weightlifting and high-intensity extreme conditioning programs most often involve the shoulders and back. These injuries are often linked to improper form and using too much weight too quickly. While some Soldiers choose to wear back braces during weightlifting, substantial evaluation of this equipment has not shown them to reduce injury. As is true of a running PT program, in order to avoid injuries, a strength training PT routine should adhere to the principles of moderation, slow progressive increases and proper form.
• Military training activities such as parachuting and combatives have also been associated with high rates of certain injuries. Some equipment has been proven to prevent these injuries. For example, mouth guards are required during combatives, as they are proven effective at reducing painful and costly teeth and mouth injuries. Ankle braces, though not required, have actually been proven as an effective tool to significantly reduce parachuting ankle injuries.
Soldiers can prevent injuries and improve fitness by slowly increasing levels of exercise, avoiding overtraining and adhering to scientifically proven exercise regimens. When injuries occur, proper rehabilitation time is a must. Improperly treated injuries can — and do — become chronic debilitating conditions.
“The duration, frequency, level and type of exercise activity, however, should be balanced against known injury risks,” said Dr. Bruce Jones, physician and injury prevention program manager at the USAPHC. “Regardless of how fit and how strong you are, an injured back, a sprained ankle, a stress fracture, a torn shoulder ligament can put you out of commission for days, weeks or longer.”
Author’s note: The Army’s Institute of Public Health has studied Army injury trends and risk factors for years and published numerous articles and reports on these topics. Technical references can be provided by contacting the program at firstname.lastname@example.org. The program is also currently developing educational products to help increase awareness of common physical training-related injuries and prevention tactics.